The premature neonate with an elevated temperature, lethargy, pale extremities, and flash central capillary refill is likely septic; therefore, a sepsis evaluation should be performed. If the patient was well-appearing with an elevated temperature, then the appropriate action would be to decrease ambient temperature and reassess in one hour. The patient’s symptoms without the elevated temperature might indicate the need for an echocardiogram to rule out cardiac defects, but the clinical picture indicates sepsis.